Four percent of Latino men who participated in a community-based survey in California said both that they were heterosexual and that they had had sex with men. These men were more likely than those who had had sex only with women to report characteristics and behaviors that could put their partners at risk of acquiring an STD: They had elevated odds of having had an STD and of having engaged in unprotected sex with a woman. Meanwhile, they were only marginally more likely than other heterosexual men to think of themselves as having a medium or high risk of acquiring HIV.1
The sample of 680 men were recruited in 2005–2006 at 12 venues in San Diego County, including five places that were thought to be (or to be near) sites where risky sexual behavior occurs. Men were eligible to participate if they were Latino, were at least 18 years old and were alone or in the company of other men. Participants took a self-administered survey that asked about their demographic characteristics, sexual orientation, lifetime history of STD testing, and lifetime and recent sexual behavior and substance use.
In all, 92% of men identified themselves as heterosexual, 2% as bisexual and 5% as gay. However, sexual identity was not always consistent with sexual behavior. Whereas 88% of participants considered themselves heterosexual and had had sex only with women, 4% considered themselves heterosexual and had had both female and male partners; 2% said that they were bisexual and had had partners of both genders, and 5% identified as gay and had had sex only with men.
Within the 60 days before the survey, 57% of men had had intercourse with a woman, 4% had had insertive anal intercourse with a male partner and 4% had had receptive anal sex. About half of men reporting each of these activities reported not having used condoms. In bivariate analyses, heterosexual men who had had both male and female partners were significantly more likely than other heterosexual men or bisexual men to report recent unprotected intercourse with a woman; gay men were the most likely to report recent receptive anal intercourse.
Sexual intercourse with a female was compared across categories of sexual identity and behavior, with controls for age, education, marital status, acculturation and type of survey venue. (The numbers of men reporting anal sex were too small to examine in a multivariate context.) In this model, heterosexual men who had had partners of both genders were significantly more likely than other heterosexual participants to report recent intercourse with a woman (odds ratio, 2.5) and recent unprotected intercourse with a woman (3.5).
The prevalence of other risk-related behaviors varied widely by sexual identity and behavior in bivariate analyses. For example, 53% of gay men were carrying condoms when surveyed, compared with 21–23% of heterosexual men; roughly 60-–70% of gay and bisexual men thought they had a medium or high risk of acquiring HIV, compared with about 25–40% of heterosexual men. Of those who had had an STD test, heterosexual participants who had had partners of both genders were more likely than those who had had only female partners to have had an infection.
Multivariate analyses revealed substantial differences in risk-related behavior between heterosexual men who had had partners of both genders and those who had had sex only with women. The former were significantly more likely than the latter to report using alcohol and drugs during sex (odds ratios, 3.3 and 6.2, respectively), to have been tested for HIV or other STDs (4.5 and 4.2) and, if they had been tested, to have had an STD (4.3); despite their levels of risky behavior, however, they were only marginally more likely to consider their HIV risk medium or high. By contrast, bisexual men had significantly elevated odds of considering their level of risk medium or high (7.4) and of having been tested for STDs (3.1). Gay men also had an increased likelihood of reporting these behaviors (4.8 and 3.7, respectively); in addition, they were more likely than heterosexual men reporting only female partners to have had condoms with them at the time of the survey (3.3), to have been tested for HIV (11.3) and to be planning to have an HIV test in the next six months (2.7).
The researchers acknowledge that their findings may have been influenced by a number of factors, including their use of lifetime sexual activity to classify men behaviorally, limitations of their sample and the omission of same-sex behavior other than anal intercourse. Nevertheless, they contend that their findings have "significant implications." Nationwide estimates of the share of HIV infection attributable to bisexual behavior "rely on openly reported bisexual behavior." These findings, however, demonstrate that men may underreport same-sex behavior and that underreporting "may lead to an underestimation of the contribution that this transmission avenue makes to the HIV epidemic in the United States." In the Latino community, where cultural attitudes force many people to hide same-sex behavior, the researchers conclude that there is a vital need for prevention programs that are "consistent with and respectful of" individuals' sexual identities and that reduce stigma associated with same-sex intercourse.—D. Hollander
REFERENCE
1. Zellner JA, The interaction of sexual identity with sexual behavior and its influence on HIV risk among Latino men: results of a community survey in northern San Diego County, California, American Journal of Public Health, 2009, 99(1):125–132.